title: Management of flap venous congestion: the role of heparin local subcutaneous injection.
abstract: OBJECTIVE
  The study aimed to propose an alternative salvage technique based on local subcutaneous injection of low molecular-weight heparin (LMWH) for the management of venous congested pedicle and free flaps in which venous outflow could not be surgically restored.
  
  
  METHODS
  A retrospective review of all patients who received the proposed protocol at a single centre was performed.
  
  
  RESULTS
  Fifteen patients were treated (six free flaps and nine regional flaps). The LMWH protocol was applied for a mean of 11 days (10-14 days). Thirteen patients required transfusions with a mean number of 5 U (0-12 U) of packed red blood cells (PRBCs) transfused per patient. All flaps were successfully salvaged (seven totally and eight partially). There were two associated complications: one patient developed a recipient-site haematoma and another patient suffered a syncope episode, related to anaemia.
  
  
  CONCLUSIONS
  Local subcutaneous injection of LMWH was proven to be an effective alternative in improving flap venous congestion. The main advantages of this procedure are availability, easy application and local limited action. However, the associated morbidity should be balanced against the risk of flap loss and a judicious application is mandatory.
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Centre, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: mariapsempere@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Centre, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sancho
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Centre, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ferrer
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Centre, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: García
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Centre, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: J P
authors.initials: JP
authors.lastname: Barret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced; D002648:Child; D017707:Erythrocyte Transfusion; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006406:Hematoma / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006940:Hyperemia / Q000188:drug therapy* / Q000209:etiology; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D013524:Surgical Flaps / Q000009:adverse effects*; D013575:Syncope / Q000139:chemically induced; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: Flap; Heparin; Salvage therapy; Venous congestion; Venous insufficiency